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NPI Code Detail

MEDICARE: AMANDA KYLA KELLY MED, BCBA

MEDICARE: AMANDA KYLA KELLY MED, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-19-40066GA
2103K00000XBehavior Analyst1-19-40066CO
3103K00000XBehavior Analyst1-19-40066FL

General Provider Information

NPI Number : 1285108027
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA KYLA KELLY MED, BCBA
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 866-610-0580
Fax Number : 407-588-6294
Provider Business Practice Location Address
First Line : 7775 BAYMEADOWS WAY STE 200
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-7531
Country : US
Telephone Number : 904-831-3974
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2019
Last Update Date : 10/16/2024

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